Claims-FAQ

Help Centre

Frequently Asked Questions

1. How do I apply for a claim and what documents do I need to complete the process?

2. What if there is a delay in claim intimation or claim documentation?

3. What is the timeline for submitting claim documentation?

4. How can I download the claims form?

5. What are pages need to fill on claim form?

6. What is the claim intimation procedure in case of a non-network hospital?

1. How do I apply for a claim and what documents do I need to complete the process? - +

You will need the following to successfully complete the filing of a claim:

a. A claims form which has been duly completed and signed by the claimant.

b. KYC documents of the insured person in case of a cashless claim and proposer in case of a reimbursement claim.

c. Self-attested copy of a valid age proof (passport / driving license /PAN card / class X certificate / birth certificate).

d. Self-attested copy of an identity proof (passport / driving license /PAN card / voter identity card).

e. Self-attested copy of an address proof (passport / driving license / voter identity card)

f. A recent passport size photograph.

g. A cancelled cheque/ bank statement / copy of passbook mentioning account holder’s/nominee’s name (in case of death of policyholder) IFSC code and account number.

h. The original discharge summary.

i. Some additional documents which will be required in case of surgery/surgical procedure: original surgical notes, pre-anaesthesia check-up report, barcode sticker and invoice for implants and prosthesis (if used) and indoor case paper/OT notes.

j. An original bill from the hospital with the detailed break-up as well as the paid receipt.

k. Room tariff of the entitled room category (in case of a non-network provider): duly signed and stamped by the hospital.

l. The original bills of the medicines/pharmaceuticals purchased. Also required for any other investigation done outside the hospital along with reports and requisite prescriptions.

m. A copy of the death certificate (in case of demise of the insured person).

n. In case of medico-legal cases (MLC) or accidents- MLC/First Information Report (FIR) copy attested by the concerned hospital / police station or original self-narration of incident in absence of MLC / FIR.

o. The original first consultation paper (in case illness is diagnosed for the first time).

p. The original laboratory investigation, diagnostic & pathological reports with supporting prescriptions.

q. The original X-Ray/ MRI / ultrasound films and other radiological investigations.

Is this in place of the insured person or is this a separate document of its own?

2. What if there is a delay in claim intimation or claim documentation? - +

If the claim is not notified to NivaBupa or the documents are not submitted within the stipulated time as mentioned in the above sections, then you shall have to provide to us a written reason for the delay. We will condone such a delay if it has been proved to be for reasons beyond the claimant's control.

3. What is the timeline for submitting claim documentation? - +

The document should be provided with the necessary information in respect of all claims at your/the insured person's expense within 30 days of the insured person's discharge from the hospital (in the case of pre-hospitalisation medical expenses and hospitalisation medical expenses) or within 30 days of the completion of the post-hospitalisation medical expenses period (in the case of post-hospitalisation medical expenses) or within 30 days of death or disability due to accident (in case of personal accident cover).

4. How can I download the claims form? - +

Visit www.nivabupa.com and click on “claims”.

Then select claim form in the drop down and then click on services form and download the form as per your plan.

5. What are pages need to fill on claim form? - +

In case of Heartbeat/Health Companion plan:

If the form is downloaded from the website, it is of 11 pages. Please fill page numbers 1,2,9,10,11.

If the form is received through IVR/helpline, it is of 16 pages form. Please fill page numbers 6,7,14,15,16.

6. What is the claim intimation procedure in case of a non-network hospital? - +

The claims for which cashless facility has not been pre-authorised or for which treatment has not been taken at a network provider, you should inform us of the claim along with the following details. This has to be done within 48 hours of admission to the hospital or before discharge from the hospital, whichever is earlier:

1. The policy number.

2 The patient’s name.

3 The hospital’s name, complete address and contact number.

4 Name of the attending medical practitioner.

5 Date of admission and expected date of discharge.

6 The nature of illness/injury and the treatment/surgery taken.

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GoActive™

HeartBeat

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